肾动脉狭窄支架术现状

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1、Renalstentinginrenalarterystenosis----contentedanduncontented肾动脉狭窄支架术patients发病率(%)Generalpeople0.1Hepertension1-5<50y,withHT(FMD)4-5>50y,wiht(ARAS)HT15CAD10-19criticalHT30HT+CAD20-30ESRD15-20HT+CAD+PVD40-60HT+CAD+Renaldysfunction40-60Prevalenceofrenalarterystenosis(RAS)ARAS9

2、0%FMD10%CommoncausesofrenalarterystenosisHTRenaldysfunctionAnginapectorisParoxysmalacutepulmonaryedemaPresentationofrenalarterystenosisHaemodynamics:>50%Renalperfusionpressurereduction>70%RPP<75-85mmHg,autonomicregulationlosePathology:Glomcrulus：arteriosclerosis,mesenteriumpr

3、oliferation，Nephrictubule：epithelialcellsdenudation、apoptosis,Focalnecrosis，Renalinterstitium：Inflammatorycellinfiltration、fibrocyteproliferationEndstage：renalatrophyAtheroscleroticnephrosisNaturalcourseofARASstudyNF/U(mon)prograssion(%)Occlusion(%)Caps17033519Zierler80244811

4、Tollefson4854539Schreiber85524416Developtototalocclusionwithin5years15%Deteriorationgraduallywithin5years10-20%DeveloptoESRDannually5-15%3-yearmortalityinPt.withESRDondislysis50%SurvivalofARASPt.withESRDondislysis:5-year18%10-year5%AtheroscleroticRASprogressionConlonetal,Kidn

5、eyInt2001Oct;60:490-7Renalangioin3987Pt.undergoingcathIndependentpredictorofmortalityConlonetal,KidneyInt2001Oct;60:490-7Renalangioin3987Pt.undergoingcathIndependentpredictorofmortalityCase1:male，62y，HTCase2:male,78y，HT,DM,RenaldysfunctionRenalfunction:improement：GFRincrese15

6、%/Scrdecrease0.2mg/dLstable：GFRchange<15%/Scrchange<0.2mg/dLineffective：GFRdecrease>15%/Scrincrease>0.2mg/dLbenefit：ImproementorstableBloodpressure:cure：SBP<140mmHgandDBP<90mmHg,withoutanyanti-hypertensiondrugs，improement：SBP<140mmHgandDBP<90mmHg,or,DBPdecrease>15mmHgwithsimi

7、larorlessanti-hypertensiondrugsineffective：BPchangenotmeettheabovestandardbenefit：cureandimprovementStandardforprognosisevaluationafterrenalarterystenting(Rundback)RenalarterystentingsuccessratestudyNProceduralsuccess(%)Burket127100Rodriguez10898Rocha15097QueenMaryhospital641

8、00RuijinHospital12899PTRAonhepertensionstudyF/U(m)caursecure(%)Impro